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See a sample rate comparisonCPT 76499 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Unlisted Diagnostic Radiologic Procedure
| Key Fact | Detail |
|---|---|
| Service Type | Radiology Procedures Diagnostic Radiology (Diagnostic Imaging) Procedures |
| Common Place of Service | 11 - Office 24 - Ambulatory Surgical Center |
| Common Modifiers | None 26 - Professional component TC - Technical component |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 76499 |
National average reimbursement for CPT 76499 by major payers:
$1,196.10
$394.94
$400.53
$241.99
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CPT 76499
5 of 25 sample ratesHigher to lower in this preview
Inova Health Care Services, Inova Loudoun Hospital
Inova Health Care Services
$227.17Published rateSt Francis Medical Center, Inc
St Francis Medical Center Inc
$182.02Published rateJackson Hma LLC, Merit Health Central
$159.61Published rateLehigh Hma LLC, Lehigh Regional Medical Center
$95.76Published rateLarkin Community Hospital Inc
Larkin Community Hospital, Inc.
$45.88Published rate
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See a sample payer proposalCPT 76499 vs. Other Diagnostic Radiology (Diagnostic Imaging) Procedures Codes
The CPT 76499 code is part of the Radiology Procedures services used for Diagnostic Radiology (Diagnostic Imaging) Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 76499 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 76498-CPT | Moderate | Mri Scan, An Mri (Magnetic Resonance Imaging) Uses A Strong Magnetic Field To View An Area Of The Body. Multiple Images May Be Taken. |
| 76499-CPT | High | Unlisted Diagnostic Radiologic Procedure |
| 76604-CPT | Low | Ultrasou Chst (Inclu Mediastinum) Real Time W/ Image Documen, Ultrasound Chest (Includes Mediastinum) Real Time With Image Documen |
| 76800-CPT | Low | Echography, Spinal Canal & Contents |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 76499. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 76499 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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